Women with drug‐resistant epilepsy: Surgery or pregnancy first?

• Published in: Epilepsia (Copenhagen) Vol. 61; no. 8; pp. 1758 - 1763
• Main Authors: Kandraju, Sai Satish, Jose, Manna, Salini, Reshma A., Pavithran, Veena, Samuel Peedicail, Joseph, Menon, Ramsekhar N., Radhakrishnan, Ashalatha, Cherian, Ajith, Abraham, Mathew, Vilanilam, George C., Thomas, Sanjeev V.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-08-2020
• Subjects: Abortion, Spontaneous - epidemiology; Adult; Anticonvulsants - therapeutic use; antiepileptic drug; Congenital Abnormalities - epidemiology; Congenital defects; Convulsions & seizures; Developmental Disabilities - epidemiology; Drug dosages; Drug Resistant Epilepsy - therapy; Epilepsies, Partial - therapy; Epilepsy; epilepsy surgery; Female; Fetuses; Humans; Infants; malformations; Neurosurgical Procedures - methods; Pregnancy; Pregnancy Complications - drug therapy; Pregnancy Outcome; Premature Birth - epidemiology; Registries; Seizures; Statistical analysis; Surgery; Time Factors; Young Adult; epilepsy surgery; malformations; antiepileptic drug; pregnancy
• ISSN: 0013-9580; 1528-1167
• DOI: 10.1111/epi.16613

Objective
We compared women with drug‐resistant focal epilepsy who had undergone surgery (WWE‐S) with those who were managed medically (WWE‐M) for maternal and fetal outcomes of their pregnancies.
Methods
We classified all WWE‐S who were enrolled in a prospective registry of epilepsy and pregnancy (1998‐2015) as those who underwent the surgery before pregnancy (WWE‐SF) or after pregnancy (WWE‐PF). The comparator group (WWE‐M) was twice that number of age‐matched women with focal epilepsy in this registry. Their clinical profile, anti‐epileptic drug (AED) use, and pregnancy outcomes were extracted from the records of the registry.
Results
The number of completed pregnancies with known outcome was 74 for WWE‐S (67 WWE‐SF and 7 WWE‐PF) and 134 for WWE‐M. Seizures increased during pregnancy for fewer WWE‐SF than for WWE‐M (14.9% vs 39.6%, P = .001). Compared to WWE‐M, fewer WWE‐SF had dose escalation during pregnancy (28.4% vs 14.9%, P = .025). Preterm deliveries were more frequent in WWE‐SF than WWE‐M (24.6% vs 12.2%, P = .029). The differences between the WWE‐SF and WWE‐M regarding the rates of fetal loss (10.4% vs 6.7%, P = .255), major congenital malformations (8.5% vs. 11.1%, P = .395), and development quotient at 1 year of age <85 (42.5% vs 42.3%, P = .569) were not statistically significant. Compared to WWE‐PF, fewer WWE‐SF had AED dose escalation (14.9% vs 85.7%, P = .001) or increase in seizures (14.9% vs 100%, P = .001) during pregnancy. WWE‐SF had fewer infants with development quotient <85 (41.0% vs 100%, P = .005).
Significance
WWE‐SF can expect better control of seizures and decreased AED burden during pregnancy than WWE with focal epilepsies managed with medicines only. WWE who undergo surgery for epilepsy before their pregnancies can expect fewer seizures and lower AED burden during pregnancy.